People are finding it almost irresistible to speculate about the diagnosis in the unavoidably omnipresent case of Britney Spears. Frankly, we just don't know what, if anything, is her diagnosis. The only people who know what is most probably wrong with her will be the doctors treating her and those asked to examine her and report to the Court. And they would be bound by professional rules of confidentiality, with one exception, which she seems to be recurrently risking.

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Clinical confidentiality
A treating doctor would be bound not to disclose information about his patient except with her expressed consent. But a doctor specifically asked by a court to examine someone to determine their mental state, and to make recommendations about the likely diagnosis, best management, fitness to care for themselves or others, and to manage their affairs, has a primary duty to the court, and not to the patient. They are expected, as an expert witness, to report in detail to the court on their decisions, findings, and the basis for their opinions, and may be questioned and cross-examined about these matters.

Such hearings should be in open court, and thus could be reported widely. While sometimes, such as to protect minors, a hearing might be heard in camera (privately) it would be outrageous for a court to provide special privacy for a celebrity so as to avoid them embarrassment at what might be disclosed - if ordinary people would not be given the privilege of such privacy. Celebrities have no legal or moral basis to expect to be treated differently.

We recently saw Britney compulsorily admitted to hospital, and her father given control over her affairs by a judge. The more she challenges such decisions, and if she wishes to argue in court that she is fit to care for her children, the more relevant everything about her recent behaviour and the results of medical examinations, would become to such hearings. So there may be a great deal more information about her mental state revealed in court, and then to the media, before long.

How might we explain her public behaviour?
Because she has chosen to make her eccentric behaviour so public so frequently, a great deal has been seen and heard, and is resolutely in the public domain, and has, very reasonably, given rise to speculation as to what may be the matter.

What have we seen? Behaviour that has fairly consistently and over an extended period of time, been disorganised, sometimes seeming chaotic, stubborn, self-defeating, impulsive, thoughtless, and frankly foolish. Embarrassing as it would be to anyone else, she seems immune from feeling embarrassed.

Attention-guzzling
In another person, we might think of it as "attention-seeking" - but doesn't she have enough attention already? Or is she insatiable when it comes to the attention of others? Some celebrities become hooked on the celebration, and feel anxious when nobody seems to be paying attention, even for a short time. It has become fashionable to blame "the media" and more specifically "the paparazzi" for the ills of such creatures of the flash-bulb.

But celebrities profit mightily from being celebrated, and depend on the public paying close attention to them and their activities. They work hard (for some, it's about the only really hard work they do) to stir up and encourage such attention, and cannot then insist on privacy. There's often a paradox, in which someone who is constantly attention-seeking (and -getting) complains of loss of privacy. And if you placed them somewhere truly private, they'd probably call the photographers in. They can't guzzle the public gaze as they do, and then expect to suddenly switch it off when it suits them.

How to avoid the paparazzi
The best way to get the paparazzi and press to lose interest, is, simply, to be unfailingly boring in all public appearances. There are many major stars of stage, CD and screen, about whom we know very little, and who seem to have no great difficulty in keeping their private life private.

But then, none of them tend to wade into a baying mob of photographers while knicker-less.

Excuses, excuses
Someone described her behaviour as "a cry for help"- why choose such an elaborate and highly inefficient and prolonged way of seeking assistance, rather than simply asking for help? Another said that she was struggling under the strain of trying to live up to the expectations of her fans. What are those expectations? How does she know what the fans expect?

Most, I suspect, just expect her to behave like some sort of adult, and they have been disappointed, not demanding.

What explanations are available?
We have seen a long-standing pattern of maladaptive and rather daft behaviour. How, in general terms, might a mental health expert explain such conduct? It's hard to dismiss it as entirely normal or usual. Bipolar disorder has been suggested, but what we've seen and heard doesn't really fit that pattern, though the diagnosis has become fashionable in some quarters and might appeal to a celebrity's physician.

In a manic phase one can indeed see such a gross lack of wisdom or even common sense, lack of inhibition and even showing off. But this has been rather an extended period for a manic episode, and there has been nothing to suggest a major depressive episode in her recent history. Similarly, there has been nothing suggesting anything psychotic. If there has been variable abuse of drugs, uppers and downers, with some periods of consistent use and other episodes of withdrawal, this might fit some of what has been seen publicly.

Personality disorder
Overall, what strikes me most in her public conduct, has been a pattern of stubborn, wilful, immature foolishness. So there could be a personality disorder, exaggerated by the peculiar circumstances that attend a rich celebrity. Though many aspects of their lives may seem enviable to the rest of us, personality and immaturity problems can be greatly inflamed and exaggerated by being able to afford almost anything you want, and by being surrounded by people who will get you whatever you wish, and who, wishing to retain access to you, are unlikely to ever criticise you or expose you to simple reality testing.

Celebrities are generally surrounded by current and would-be exploiters, like a shark surrounded by pilot fish, eager to feed on the scraps that drop from their mouths, and who prefer to blame others for situations they help to create and maintain.

(Professor M.A. Simpson, aka CyberShrink, February 2008)
 

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